415600874-1-25-2023-14-AS-CSMH-CS5V53-20230524160715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600874
Report Date: 01/25/2023
Date Signed: 01/25/2023 12:23:48 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2023 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230106124739

FACILITY NAME:	BROOKDALE REDWOOD CITY		FACILITY NUMBER:	415600874
ADMINISTRATOR:	MONICA CERON TAPIA		FACILITY TYPE:	740
ADDRESS:	485 WOODSIDE RD		TELEPHONE:	(650) 366-3900
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY:	130	CENSUS: 72	DATE:	01/25/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Monica Ceron Tapia		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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- Facility is not allowing residents to reject 24-hour care services
- Facility is not providing a reasonable level of personal privacy for residents
- Facility is not treating residents with dignity

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding the above allegations. LPA met with the executive director Monica Tapia and explianed purpose of today's visit.

During the course of the investiation LPA Vado conducted multiple interviews and made facility observations. It's discovered that the resdient developed dementia over the time he has resided at the faciltiy. Due to the resident wandering from his room into the facility, also failing to comply with facility sign in and out policy, and leaving the faciilty unsupervised with a formal diagnosis of dementia it puts the resident at risk. The facility does not provide one on one supervision of residents but in order to help with the supervision of the resident, the facility hired a staff person from an outside agency to supervise the resident when he leaves his room.

Continued on attached LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 14-AS-20230106124739

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BROOKDALE REDWOOD CITY	FACILITY NUMBER: 415600874
	VISIT DATE: 01/25/2023

NARRATIVE

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Page 2 - LIC9099C

The hired agency staff person sits outside in a chair positioned adjacent to the room door of the resident. The chair does not block the door of the resident's room. LPA observed this chair on two occasions, one time the private caregiver was sitting in the chair, and another time the chair was there but the private caregiver was not present. According to staff interviewed, this private caregiver only assists and supervises the resident when he leaves the room to go on walks outside of his room. The private caregiver does not assist the resident in his room despite that option being made available. The resident has declined this service of assistance. The caregiver does not interfere with the resident when he is in his room and does not sit or supervise the resident while he is in his room. The facility insists that this extra measure of supervision is in place to provide additional care and supervision to the resident.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. No citations are issued. This report is reviewed with executive director Monica Tapia.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC9099 (FAS) - (06/04)

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